Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database

Abstract

Objectives To evaluate the association of frailty, a measure of diminished physiologic reserve, with both major and minor surgical complications among patients undergoing urologic surgery. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013, we identified all urologic cases that appeared more than 1000 times in the dataset among patients age 40 and older. Frailty was measured using the NSQIP Frailly Index (FI), a validated measure that includes 11 impairments such as decreased functional status and impaired sensorium. We created multivariable logistic regression models using the NSQIP Frailty Index to assess major and minor complications after surgery. Results We identified 95,108 urologic cases representing 21 urologic procedures. The average frequency of complications per individual was 11.7%, with the most common complications being hospital readmission (6.2%), blood transfusion (4.6%), and urinary tract infection (3.1%). Major and minor complications increased with increasing NSQIP-FI. Frailly remained strongly associated with complications after adjustment for year, age, race, smoking status, and method of anesthesia [adjusted OR 1.74 (95% CI 1.64, 1.85) NSQIP-FI 0.18+]. Increasing NSQIP-FI was associated with increasing frequency of complications within age groups (by decade) up to age 81 and across most procedures. Conclusion Frailty strongly correlates with risk of post-operative complications among patients undergoing urologic surgery. This finding is true within most age groups and across most urologic procedures.

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

“…Our results are in agreement with Suskind et al, 30 where frailty was strongly associated with both major and minor complications among patients undergoing urological surgery. However, Suskind et al 30 defined frailty according to the National Surgical Quality Improvement Program (NSQIP). Although this frailty index is a multidimensional score, it heavily relies on comorbidities.…”

The importance of frailty: Know thy patient

“…Two important findings from the study deserve mention. While normal ageing‐related changes may contribute substantially to greater frailty, as has been seen previously , this study shows that the effect of frailty was apparently not modified by patient age: for patients aged <80 years, increasing frailty independently predicts perioperative morbidity and mortality within each age group. Along with results by Revenig et al.…”

“…Along with results by Revenig et al. , suggesting physician's subjective assessment of frailty may be over‐reliant on patient age, this study serves as a reminder for objective evaluation of frailty (even in younger patients) being considered for urological surgery. Along a similar note, while there was substantial heterogeneity in the association between increasing NSQIP‐FI and complications across different urological surgeries, patients undergoing apparently minor procedures (such as TURP and hydrocoele) had unintended complications if they had a greater frailty index, the second important finding of this study.…”

“…In this issue of the BJUI , Suskind et al. used data from a large, national, prospectively designed surgical quality improvement initiative [the American College of Surgeons National Surgical Quality Improvement Program ® (ACS‐NSQIP)] to correlate patient frailty [measured using a previously validated 11‐point NSQIP‐Frailty Index (FI)] with 30‐day postoperative outcomes for 21 common urological procedures. While two‐thirds of the cohort was aged >60 years, interestingly, 80% had no more than one frailty item.…”

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table  1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”